m 

6

  
  



 


    

Betty Neuman·s system model provides a comprehensive    
flexible holistic and system based perspective for The Orem model is based upon the philosophy that all
nursing. This is based on the individual·s relationship to patients wish to care for themselves. They can recover
stress, the reaction to it, and the recostitution factors more quickly and holistically if they are allowed to
that are dynamic in nature. perform their own self cares to the best of their ability.
M
M Ô  Mm 
 Mm 


m M

 the variables of the person in Ô    
 
interaction with the internal and external m îir
environment comprise the whole client system m Water
m   
 î system in which there is m Food
continuous flow of input and process, output m Elimination
and feedback. It is a system of organized m îctivity and Rest
complexity where all elements are in m Solitude and Social Interaction
interaction. m Hazard Prevention
m 
    

  Interventions m Promotion of Normality
modes for nursing action and determinants for
entry of both client and nurse in to health care Self care requisites are groups of needs or
system. requirements that Orem identified. The nurse is
m m


 The return and maintenance of encouraged to assign a support modality to each of the
system stability, following treatment for self care requisites.
stressor reaction, which may result in a higher When an individual is very unable to meet their
or lower level of wellness. own Self care requisites, a M
occurs. It
m 

 î state of balance of harmony is the job of the Registered Nurse to determine these
requiring energy exchanges as the client deficits, and define a support modality.
adequately copes with stressors to retain,
attain, or maintain an optimal level of health 

 

thus preserving system integrity. Nurses are encouraged to rate their patient's
m 
   environmental factors, intra dependencies or each of the self care deficits on the
(emotion, feeling), inter (role expectation), and following scale:
extra personal (job or finance pressure) in m Total Compensation
nature, that have potential for disrupting m Partial Compensation
system stability. m Educative/Supportive
 



   , 79, a pioneer in the development 
of nursing practice theory between the late 1950s and 

  
1980s "My thesis is that nursing art is not comprised of
6 

  rational nor reactionary actions but rather of
Johnson proposed that nursing care facilitated the deliberative action." - Wiedenbach, 1964
client's maintenance of a state of equilibrium. Johnson  
 &  was an early nursing leader who
proposed that clients were "stressed" by a stimulus of is probably best known for her work in theory
either an internal or external nature. These stressful development and maternal infant nursing.
stimuli created such disturbances, or "tensions," in the
patient that a state of disequilibrium occurred. Johnson   !"

identified two areas that nursing care should be based in 

order to return the client to a state of equilibrium. First, Wiedenbach believed that there were ÿ 
by reducing stressful stimuli, and second, by supporting 

    #. They included: 
natural and adaptive processes. Johnson's behavioral  " "
 


system theory springs from Nightingales belief that 

nursing's goal is to help individuals prevent or recover
from disease or injury. The "science and art" of nursing
should focus on the patient as an individual and not on
the specific disease entity. Johnson used the work of
behavioral scientists in psychology, sociology, and
ethnology to develop her theory. The model is patterned
after a systems model; a system is defined as consisting
of interrelated parts functioning together to form a
whole (Conner et. al. 1994).
Johnson states that by categorizing behaviors,
they can be predicted and ordered. Johnson categorized
all human behavior into
 




: needs and desires of the patient. In providing care, a
!
Wiedenbach conceptualizes nursing as the
practice of identification of a patient's need for help
through observation of presenting behaviors and
symptoms, exploration of the meaning of those
symptoms with the patient, determining the cause(s) of
discomfort, and determining the patient's ability to
resolve the discomfort or if the patient has a need for
help from the nurse or other healthcare professionals.
Nursing primarily consists of identifying a patient's need
for help. If the need for help requires intervention, the
nurse facilitates the medical plan of care and also
creates and implements a nursing plan of care based on


"!
"!##

"  " nurse exercises sound judgment through deliberative,
$"% #

"  
. Each subsystem is practiced, and educated recognition of symptoms. The
composed of a set of behavioral responses or patient's perception of the situation is an important
tendencies that share a common goal. These responses consideration to the nurse when providing competent
are developed through experience and learning and are care
determined by numerous physical, biological,
psychological, and social factors.m 
 
#  
  

$ !


 
#
 # (1820-1910), considered the )#" was a nursing theorist whose
founder of educated and scientific nursing and widely seminal work ´Interpersonal Relations in Nursingµ was
known as "
'(


'" She is considered published in 1952.
the first nursing theorist. Nightingale's theory was
shown to be applicable during the Crimean War when $ !


she, along with other nurses she had trained, took care
of injured soldiers by attending to their immediate
needs, when communicable diseases and rapid spread
of infections were rampant in this early period in the
development of disease-capable medicines.
Dr. Peplau emphasized the nurse-
client relationship as the foundation of nursing practice.
ît the time, her research and emphasis on the give-and-
take of nurse-client relationships was seen by many as
revolutionary. Peplau went on to form an interpersonal
 
  model emphasizing the need for a partnership between
nurse and client as opposed to the client passively
  


!
 #)
 receiving treatment (and the nurse passively acting out
m Environmental doctor's orders).
m Pure or fresh air
m Pure water The essence of Peplau's theories is the creation of
m Sufficient food supplies a shared experience. Nurses, she thought, could
m Efficient drainage facilitate this through observation, description,
m Cleanliness formulation, interpretation, validation, and intervention.
m Light (especially direct sunlight) For example, as the nurse listens to her client she or he
develops a general impression of the client's situation.
îny deficiency in one or more of these factors The nurse then validates his or her inferences by
could lead to impaired functioning of life processes or checking with the client for accuracy. The result may be
diminished health status. experiential learning, improved coping strategies, and
The factors posed great significance during personal growth for both parties.
Nightingale's time, when health institutions had poor +
 

 #m

sanitation, and health workers had little education and
training and were frequently incompetent and unreliable m Stranger role
in attending to the needs of the patients. îlso m Resource role
emphasized in her environmental theory is the provision m Teaching role
of a 
or 
* and (  
, m Counseling role
attending to patient's dietary needs by assessment, m Surrogate role
documentation of time of food intake, and evaluating its m îctive leadership
effects on the patient. m Technical expert role:
  
%
 
 %  &


While at Yale she was project investigator of a National %# - #( January 30, 1923 ² December 24, 2007)
Institute of Mental Health grant entitled: Integration of was universally recognized as a pioneer of nursing
Mental Health Concepts in a Basic Nursing Curriculum. It theory development.
was from this research that Orlando developed her  '
theory which was published in her 1961 book, 
 "

 

 



,

 . She furthered
the development of her theory when at McLean Hospital The theory describes a dynamic, interpersonal
in Belmont, Mî as Director of a Research Project: Two relationship in which a person grows and develops to
Systems of Nursing in a Psychiatric Hospital. The results attain certain life goals. The factors which affect the
of this research are contained in her 1972 book attainment of goal are roles, stress, space & time.
titled: 
   

  

  


. îccording to King, health involves dynamic life
experiences of a human being, which implies continuous
  
 
$

 adjustment to stressors in the internal and external

environment through optimum use of one·s resources to
Orlando's theory was developed in the late 1950s achieve maximum potential for daily living
from observations she recorded between a nurse and
patient. Despite her efforts, she was only able to


- #.

categorize the records as "good" or "bad" nursing. It
then dawned on her that both the formulations for
"good" and "bad" nursing were contained in the records.
From these observations she formulated the deliberative
nursing process. The role of the nurse is to find out and
meet the patient's immediate need for help. The patient's
presenting behavior may be a plea for help, however, the
help needed may not be what it appears to be. Therefore,
nurses need to use their perception, thoughts about the
perception, or the feeling engendered from their
thoughts to explore with patients the meaning of their
behavior. This process helps the nurse find out the
nature of the distress and what help the patient needs.
Orlando's theory remains one the of the most effective
practice theories available.

m If perceptual interaction accuracy is present in
nurse-client interactions, transaction will
occur.
m If nurse and client make transaction, goal will
be attained.
m If goal are attained, satisfaction will occur.
m If transactions are made in nurse-client
interactions, growth & development will be
enhanced.
m If role conflict is experienced by nurse or client
or both, stress in nurse-client interaction will
occur.
m If nurse with special knowledge skill
communicate appropriate information to client,
mutual goal setting and goal attainment will
occur.